This article was originally posted on AJMC.com.
During World Health Care Congress 2019, healthcare stakeholders from around the globe convened to discuss all things healthcare, ranging from Medicare for All to social determinants of health. Here are 5 things to know from the conference:
1. Medicare for All alternative
Criticizing the idea of Medicare for All, Senator Bill Cassidy, MD, R-Louisiana, argued that the legislation would give government more power over the patient rather than give the patient power over their healthcare. He outlined his alternative to reorganizing the healthcare system. The plan, modeled after the Children’s Health Insurance Program (CHIP) and referred to as CHIP 2.0, would move away from a flat rate per patient and instead allow the federal government to look at a state’s expansion population and individual exchanges and offer adjusted rates based on the health status and demographics of the population. This, said Cassidy, would allow states to offer healthcare tailored to their specific populations.
Cassidy also discussed several other healthcare issues on his radar, including surprise medical billing and price transparency, as well as drug competition and cost.
2. Quantifying the return on investment of social determinants of health initiatives
Once social determinants are identified and initiatives are implemented to address them, how can a health system determine the value of these initiatives to gain buy in from providers and payers? During the conference, a panel discussion explored this question, offering several approaches to doing so. Jill Feldstein, chief operating officer of Penn Center for Community Health Workers at Penn Medicine, explained that conducting randomized clinical trials is an effective way for demonstrating benefits associated with an intervention.
According to Susan Mani, vice president of Clinical Transformation and Ambulatory Quality at Lifebridge Health, health systems should create a business case by putting money amounts behind measures, such as prevented readmissions. Population health should be addressed in the same way as any other service line, such as cardiology. Other initiatives put forward by the panel included predictive analytics and paying attention to not just endgame outcomes but also process outcomes, such as referrals to social service organizations.
3. Lessons learned in the shift to value-based care
Another panel discussion shared lessons learned and cautionary tales for moving to value-based care. Redonda Miller, MD, president of The Johns Hopkins Hospital, warned of unintended consequences of payment policies aimed at lowering costs. For example, revenue caps might unintentionally incentivize cutting down all utilization rather than inappropriate avoidable utilization. She also explained that health systems need to be aware of the time horizon of systematic change, noting that it could take years to see the impact.
While Jason Mitchell, MD, chief medical officer and clinical transformation officer of Presbyterian Healthcare Services, advised that health systems lead the shift with the doctors and leaders in their system, Craig E. Samitt, MD, president and chief executive officer of Blue Cross Blue Shield of Minnesota, recommended the healthcare industry mirror the tactics of other industries and think more transformatively rather than incrementally.
4. The FDA’s push for innovation
Former FDA Commissioner Scott Gottlieb, MD, delivered his first speech since stepping down as commissioner, reflecting on the agency’s push for innovation under his leadership. However, with this push also came the realization that old rules don’t apply. During his speech, Gottlieb explained that with new fields of technology emerging, modern rules had to be created to regulate them.
He walked through several new areas introduced or embraced during his time in office, including gene therapies, cell-based regenerative medicine, targeted medicine, analytical tools, and electronic health records.
5. Ensuring optimal aging at home
As older Americans increasingly prefer home healthcare over care in hospitals, a session at the conference underscored the importance of balancing technology and care management to ensure optimal aging at home. A central theme that emerged from the discussion was bridging the gap between the hospital and the home, which means understanding that the key care team member might not be the physician and might instead be a nurse, an occupational therapist, or a community health worker, explained Alice Bonner, PhD, RN, former director of the Division of Nursing Homes at CMS; senior advisor on aging at the Institute for Healthcare Improvement; and adjunct faculty and director of Strategic Partnerships at Johns Hopkins School of Nursing.
Scott Code, associate director, LeadingAge Center for Aging Services Technology, added that when thinking about implementing technology in the home to better manage health or to remotely monitor patients, there needs to be the proper infrastructure in place, such as broadband, which many older adults may not have because of their financial means.